| NPI | 1386103000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.015072) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A12368) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2023-09-21 |