| NPI | 1437172103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 180001431) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166000183) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-10-27 |