| NPI | 1063654002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 180-003154) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180-003154) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2009-04-06 |