| NPI | 1063779957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180-008953) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178007583) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2014-02-13 |