| NPI | 1801005665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.001914) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166.000240) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-02-06 |