| NPI | 1194037788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180-002045) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166-000437) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2010-07-12 |