| NPI | 1093290124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180014253) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.014894) |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2025-12-15 |