| NPI | 1740812569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166001509) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 208000787) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2021-10-18 |