| NPI | 1346822442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.015709) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.016827) |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2024-09-17 |