| NPI | 1104094630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.004814) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.004814) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2024-03-13 |