| NPI | 1992515266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 150.105632) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.105632) |
| Enumeration Date | 2025-01-09 |
| Last Update Date | 2025-11-05 |