| NPI | 1770074817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011559) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 22317) |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC5908) | |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC01059800) | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2025-12-11 |