| NPI | 1275990012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180010129) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178008867) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2016-01-25 |