| NPI | 1790919272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180006395) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 8751) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2023-08-23 |