| NPI | 1942537477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180007145) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180007145) |
| 106H00000X Marriage & Family Therapist (Licence: IL 180007145) | |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2009-11-04 |