| NPI | 1114295540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 180-002908) |
| 101YP2500X Counselor Professional (Licence: IL 180002908) | |
| 102L00000X Psychoanalyst (Licence: IL 180-002908) | |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2018-03-17 |