| NPI | 1306194923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.008877) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 208.000240) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2013-09-09 |