| 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 |