| NPI | 1083043665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180010206) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178009468) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2016-07-05 |