| NPI | 1710480850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.009788) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: IL 255467) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2025-01-04 |