| NPI | 1891333811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.013236) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.014835) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2021-03-15 |