NPI | 1598116618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.012047) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 76026) |
Enumeration Date | 2016-06-30 |
Last Update Date | 2024-10-10 |