| NPI | 1922343532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.008378) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180008379) |
| 101Y00000X Counselor (Licence: IL 180.008378) | |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2023-11-13 |