| NPI | 1740744200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.016732) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2025-06-10 |