| NPI | 1306096573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180-004880) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 180-004880) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2008-09-24 |