| NPI | 1770028912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180.010564) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.010564) |
| Enumeration Date | 2016-12-26 |
| Last Update Date | 2020-04-23 |