| NPI | 1114418449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180012831) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.011209) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2020-08-31 |