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 |