| NPI | 1417205337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC009197) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 178-007226) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2017-03-24 |