| NPI | 1780085993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180.010632) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180.010632) |
| Enumeration Date | 2014-09-07 |
| Last Update Date | 2016-10-22 |