| NPI | 1821303157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7162) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180011345) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2018-11-27 |