| 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 |