| NPI | 1043699945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2008012184) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178003806) |
| Enumeration Date | 2015-05-25 |
| Last Update Date | 2015-05-25 |