| NPI | 1164197448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 85134) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.009294) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2022-07-25 |