| NPI | 1730401621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180007738) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178006014) |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2011-11-07 |