| NPI | 1982114922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.012016) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 178.012900) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2023-10-04 |