NPI | 1669594693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016625) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178002002) |
106H00000X Marriage & Family Therapist (Licence: IL 166-000678) | |
106H00000X Marriage & Family Therapist (Licence: PA MF00569) | |
101YP2500X Counselor, Professional (Licence: IL 180.003490) | |
106H00000X Marriage & Family Therapist (Licence: IL 166.000678) | |
Enumeration Date | 2007-04-03 |
Last Update Date | 2009-05-27 |