| NPI | 1629239439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166.000965) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 7040) |
| 101YP2500X Counselor Professional (Licence: IL 178.004640) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 166000965) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2016-11-08 |