| NPI | 1912009051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007752) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-003264) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 16565) | |
| 103T00000X Psychologist (Licence: OH 6108) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2024-03-05 |