| NPI | 1376052290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401018296) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180012756) |
| 101YP2500X Counselor, Professional (Licence: MI 6401016213) | |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2022-04-05 |