| NPI | 1316707185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180014608) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL 21150) |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-03-20 |