| NPI | 1437790540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166001501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 208.000749) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2021-10-04 |