| NPI | 1861162638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180016902) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178018429) |
| 101YP2500X Counselor, Professional (Licence: IL 180.016902) | |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2026-06-27 |