| NPI | 1366951857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NV CI5134) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178.011229) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2025-04-21 |