| NPI | 1528491685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 251770) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.009822) |
| 101YP2500X Counselor, Professional (Licence: IL 178.008714) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2023-08-08 |