| NPI | 1205351541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014512) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178012481) |
| 101Y00000X Counselor | |
| 101YP2500X Counselor, Professional (Licence: IL 180.011388) | |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2018-05-15 |