| NPI | 1649636077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180011813) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178011708) |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2019-04-01 |