| NPI | 1487286720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180.012717) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 108.012717) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2020-04-15 |