| NPI | 1497046338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.007907) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178.007274) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2024-01-02 |