| NPI | 1225122112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180006919) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL S46043372143) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-03-31 |