| NPI | 1396879888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2006000790) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-005454) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2024-01-03 |