| NPI | 1104178649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180015933) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 178006138) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2024-10-09 |