| NPI | 1205140811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.008325) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP1600X Counselor, Pastoral | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2013-08-01 |