| NPI | 1275834996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180007491) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 67792) |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2012-05-14 |