| NPI | 1740667385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180009932) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 8689-125) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180009932) | |
| 101YM0800X Counselor, Mental Health (Licence: WI 8689-125) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2025-09-19 |