| NPI | 1730423393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.009981) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.008592) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2016-03-07 |