| NPI | 1629473939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401017306) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180011577) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2023-12-21 |