| NPI | 1326077785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071002782) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071002782) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 24159) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 166000265) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-05-20 |