| NPI | 1285169946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4709) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.011067) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2023-12-21 |