| NPI | 1013309426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071009885) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist (Licence: VA 0810006361) | |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2020-05-13 |