| NPI | 1821366899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5311-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180018397) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2026-06-16 |