| NPI | 1437302130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 5756) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180005328) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180005328) | |
| 101YP2500X Counselor, Professional (Licence: IL 180005328) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2016-01-26 |