| NPI | 1811602097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.021700) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2022045290) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2025-09-12 |