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 |