| NPI | 1811379084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180013552) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YP2500X Counselor, Professional (Licence: IL 178.014489) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2025-01-25 |