| NPI | 1134629470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 74971) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.016078) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2025-10-02 |