| NPI | 1225175540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166.000694) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 2051) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101006070) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 7) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2012-08-30 |