| NPI | 1346721222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011769) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180011769) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2019-07-01 |