NPI | 1760494108 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180-001565) |
Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: IL 180-001565) |
101YP2500X Counselor, Professional (Licence: IL 180-001565) | |
Enumeration Date | 2006-08-13 |
Last Update Date | 2022-07-21 |