| NPI | 1023298023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: IL 1513849) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180003889) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2007-11-07 |