| NPI | 1700013422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180008138) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2009009736) |
| Enumeration Date | 2009-06-20 |
| Last Update Date | 2017-02-01 |