| NPI | 1053882704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180012224) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.013200) |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2020-07-30 |