| NPI | 1831556687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 149.018631) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.015028) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2016-07-26 |