| NPI | 1538189840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: IL 071003603) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071003603) |
| 106H00000X Marriage & Family Therapist (Licence: IL 071003603) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |