| NPI | 1851830442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180012537) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2016010174) |
| 101YP2500X Counselor, Professional (Licence: RI MHC01791) | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2025-09-19 |