| NPI | 1790111631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180010971) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.008683) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2022-07-21 |