| NPI | 1619195674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.007732) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ 16314) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2025-03-21 |