| NPI | 1740641711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 166.001217) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2014010646) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2018-10-03 |