| NPI | 1215039201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: WI 320657) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 15360-135) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15348-132) | |
| 101YP2500X Counselor, Professional (Licence: WI 4047-125) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 14303) | |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 180004694) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2024-07-12 |