| NPI | 1801022496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 097349) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180006800) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: IL BHC99999) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2025-09-25 |