| NPI | 1104949585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071-008816) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180-001119) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2014-05-19 |