| NPI | 1699770560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 3277-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-004380) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2007-07-08 |