NPI | 1720120983 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2001031963) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-004605) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2007-07-09 |