| NPI | 1063751980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011982) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.008984) |
| 106H00000X Marriage & Family Therapist (Licence: IL 208.000303) | |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2023-10-25 |