| NPI | 1972202281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.018913) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.017391) |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2025-10-21 |