| NPI | 1497299598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.015712) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2025-08-23 |