| NPI | 1821286154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180-002965) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166-000394) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2007-10-11 |