NPI | 1790301562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180013890) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178014956) |
Enumeration Date | 2020-06-17 |
Last Update Date | 2022-10-04 |