| NPI | 1730636374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180013206) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2020-10-27 |