| NPI | 1972528693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166000559) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180004160) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-03-15 |