| NPI | 1871954396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.011069) |
| 101Y00000X Counselor (Licence: IL 178.009374) | |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2024-10-14 |