| NPI | 1073706248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180000325) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: IL 3755) |
| 101YP1600X Counselor, Pastoral (Licence: MO 3755) | |
| 106H00000X Marriage & Family Therapist (Licence: MO 300086) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |