| NPI | 1376990291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 6467-125) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180010010) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2017-05-10 |