| NPI | 1972779296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180005412) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401009179) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2015-04-24 |