| NPI | 1821183328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018059) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180-000340) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.000340) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-02-08 |