| NPI | 1174121495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178016192) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.016192) |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2023-12-27 |