| NPI | 1245876408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180.015115) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC17171) |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2026-05-05 |