| NPI | 1184377921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178014399) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 12245125) |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2026-01-28 |