| NPI | 1154593473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 180.006242) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.006242) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.006242) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 180.006242) | |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2010-03-24 |