| NPI | 1942522636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.001493) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2007005810) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2010-02-22 |