| NPI | 1538705330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180.015783) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 178.014991) |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2024-07-26 |