| NPI | 1669087839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166.001567) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 208000849) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2022-07-19 |