| NPI | 1114053766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166-000557) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180-003937) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2011-04-26 |