| NPI | 1124820915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC015164) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180002804) |
| Enumeration Date | 2025-03-25 |
| Last Update Date | 2025-03-25 |