| NPI | 1972653442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C-1584) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-001241) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |