| 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 |