| NPI | 1639633373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180015517) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.014433) |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2024-03-02 |