| NPI | 1144431396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180-003609) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166-000438) |
| Enumeration Date | 2007-05-26 |
| Last Update Date | 2008-11-17 |