| NPI | 1972054294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.010578) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 008748) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2026-04-22 |