| NPI | 1023260403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0018005) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180006525) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2025-07-21 |