| NPI | 1033324074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007725) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL #1186) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MN #1459) | |
| 103TC0700X Psychologist, Clinical (Licence: CA #11830) | |
| Enumeration Date | 2007-05-12 |
| Last Update Date | 2009-07-31 |