| NPI | 1013274174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.000851) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YP1600X Counselor Pastoral | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2012-04-13 |