| NPI | 1740890813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180014723) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.70061084) |
| 101YP2500X Counselor, Professional (Licence: IL 178.016140) | |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2026-09-30 |