| NPI | 1063767366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC-13950) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 178004294) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2012-07-23 |