| NPI | 1437323235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ LAC-18751) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178.000325) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2021-08-25 |