| NPI | 1467656892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.006578) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.006578) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2008-01-22 |