| NPI | 1568635910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180005895) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3938-125) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2014-07-16 |