| NPI | 1821524984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178010972) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: IL 1811015) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |