| NPI | 1275547721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166-000292) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.003684) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2017-01-25 |