| NPI | 1407156557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 79105) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.008659) |
| 106H00000X Marriage & Family Therapist (Licence: IL 166.000932) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 203057) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2018-03-01 |