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 |