| NPI | 1194753079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401012390) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178-004371) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2024-01-02 |