| NPI | 1881184976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 180.012352) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.012590) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2019-09-13 |