| NPI | 1083759716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 005275) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180-005757) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-20 |