| NPI | 1851839864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 084957) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178008483) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2018-06-16 |