| NPI | 1861836405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.009477) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.008280) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2023-01-16 |