| NPI | 1104839646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071-007479) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180-006180) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2021-03-31 |