| NPI | 1811325137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901569) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.010570) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2024-01-04 |