| NPI | 1972946028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180011882) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178008775) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2019-01-26 |