| NPI | 1386833861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180-02592) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 002143) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2007-10-19 |