| NPI | 1336563311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401012477) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.005305) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2014-02-11 |