| NPI | 1124039367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5120-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-000950) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2013-08-20 |