NPI | 1922297340 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180006922) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178004492) |
Enumeration Date | 2007-10-22 |
Last Update Date | 2008-06-23 |