| NPI | 1558636233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.008647) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.006461) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2023-03-22 |