| NPI | 1750499398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180007424) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 7708) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2016-03-15 |