| NPI | 1346354636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180003400) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0101051) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-08-24 |