| NPI | 1811391808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA 61089107) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180009794) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2024-05-01 |