| NPI | 1861836405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.009477) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.009477) |
| 101YM0800X Counselor, Mental Health (Licence: IA 100747) | |
| 101YM0800X Counselor, Mental Health (Licence: IL 178.008280) | |
| 101YP2500X Counselor, Professional (Licence: WI 7734-125) | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2026-05-01 |