| NPI | 1710512280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180014717) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180014717) |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2025-01-25 |