| NPI | 1336533314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011219) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: IL 178.010851) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 208.000379) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2018-05-14 |