| NPI | 1356337612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180000241) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166-000890) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2014-02-07 |