| NPI | 1114582277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.017099) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401016273) |
| Enumeration Date | 2019-05-04 |
| Last Update Date | 2021-08-17 |