| NPI | 1942614730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180010833) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7990125) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2021-02-15 |