| NPI | 1851410278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.006898) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3767-125) |
| 101YP2500X Counselor, Professional (Licence: IL 178004166) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2008-05-12 |