NPI | 1770247298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.013648) |
Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.013648) |
Enumeration Date | 2021-10-30 |
Last Update Date | 2021-10-30 |