| NPI | 1770975484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.011525) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180.011525) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2024-01-26 |