| NPI | 1770022329 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: C4494) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.009745) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2024-06-10 |