| NPI | 1669367348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2020011784) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178013219) |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2025-06-11 |