| NPI | 1407460652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 178.015761) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178015761) |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2021-01-13 |