| NPI | 1215234661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 3697) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180000481) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2023-10-25 |