| NPI | 1861642282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC20959) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.006455) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2023-10-25 |