| NPI | 1689337321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.014104) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.016023) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2022-02-09 |