| NPI | 1225443716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.009082) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.009082) |
| 101YP2500X Counselor, Professional (Licence: IL 14-088) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2018-12-18 |