| NPI | 1982009197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180013911) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: IL 180013911) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2023-01-24 |