| NPI | 1639237654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071-007959) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 17120) |
| 101YM0800X Counselor Mental Health (Licence: IN 39001831A) | |
| 101YP2500X Counselor Professional (Licence: IL 180.007309) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2021-04-30 |