| NPI | 1699900746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2013030317) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.006751) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2022-10-25 |