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 |