| NPI | 1831593201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.014809) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178.008876) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2025-11-17 |