| NPI | 1649321944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.022326) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085002506) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2025-11-07 |