| NPI | 1881146769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.012972) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178011516) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2023-04-24 |