| NPI | 1821766528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.015654) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: 178.014083) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2024-03-15 |