| NPI | 1861941767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.010819) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.011053) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2018-03-17 |