| NPI | 1033649686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.013082) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 2716-226) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2017-06-15 |