| NPI | 1558673459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO 5795) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180007370) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2013-01-22 |