NPI | 1437408309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180-000792) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 1815) |
Enumeration Date | 2012-09-06 |
Last Update Date | 2013-05-06 |