| NPI | 1417440173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071.010669) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: IL 071.010669) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 071.010669) | |
| 103TC0700X Psychologist, Clinical (Licence: OK 1311) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.010669) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OK 1311) | |
| 103TF0000X Psychologist, Family (Licence: IL 071.010669) | |
| 103TH0004X Psychologist, Health (Licence: IL 071.010669) | |
| 103TH0100X Psychologist, Health Service (Licence: OK 1311) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OK 1311) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IL 071.010669) | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: IL 071.010669) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2022-01-05 |