NPI | 1184917361 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166001123) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.010958) |
Enumeration Date | 2011-05-23 |
Last Update Date | 2017-05-02 |