| NPI | 1225398415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180007701) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180007701) |
| 106H00000X Marriage & Family Therapist (Licence: IL 180007701) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2013-02-18 |