| NPI | 1982748612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180003760) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041206221) |
| 101YP2500X Counselor, Professional (Licence: IL 180.003760) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2010-11-24 |