| NPI | 1407656986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 178.021933) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 208.011442) |
| Enumeration Date | 2025-03-14 |
| Last Update Date | 2026-07-09 |