| 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 |