| NPI | 1811376783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180016256) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178-010954) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-07-21 |