| NPI | 1073018669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.012530) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.013187) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2020-04-16 |