| NPI | 1942547625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180005013) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-01-14 |