| NPI | 1811194376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180-004415) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180-004415) |
| 101YP2500X Counselor, Professional (Licence: IL 180-004415) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2010-08-24 |