| NPI | 1578813119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166.001308) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166001308) |
| 106H00000X Marriage & Family Therapist (Licence: MN 3239) | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2020-06-01 |