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 |