| NPI | 1871067355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.014463) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.014510) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2023-03-21 |