| NPI | 1912442542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0013742) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.010647) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2018-05-31 |