| NPI | 1639408214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2009035484) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.007223) |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2009-12-10 |