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 |