| NPI | 1770154130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC007743) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178013275) |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2021-07-07 |