NPI | 1043795263 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2020010460) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178013717) |
Enumeration Date | 2018-10-03 |
Last Update Date | 2022-06-10 |