| NPI | 1811184955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-23103) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180005697) |
| 101YP2500X Counselor, Professional (Licence: IL 180005697) | |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2025-05-14 |