| NPI | 1609160555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180009558) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178007348) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2017-01-12 |