| NPI | 1518207919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.009700) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178008809) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2018-07-09 |