| NPI | 1750611596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.007358) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180007358) |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2025-04-22 |