| NPI | 1205293834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011085) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.011085) |
| 103T00000X Psychologist (Licence: IL 180.011085) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: IL 180.011085) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 180.011085) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 180.011085) | |
| 103TF0000X Psychologist, Family (Licence: IL 180.011085) | |
| 103TF0200X Psychologist, Forensic (Licence: IL 180.011085) | |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2020-08-04 |