| NPI | 1689285892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 7778) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0017827) |
| 101YP2500X Counselor, Professional (Licence: IL 180013074) | |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2022-06-22 |