| 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 |