| NPI | 1043286370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.003363) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180003363) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2010-11-09 |