| NPI | 1437216363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-007464) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL IL01209) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 41195047) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2010-08-16 |