| NPI | 1730747510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 178.014871) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.014871) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2026-01-28 |