NPI | 1154593473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: IL 180.006242) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180.006242) |
101YM0800X Counselor Mental Health (Licence: IL 180.006242) | |
106H00000X Marriage & Family Therapist (Licence: IL 180.006242) | |
Enumeration Date | 2008-03-26 |
Last Update Date | 2010-03-24 |