| NPI | 1083672034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180-002585) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180002585) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-02-25 |