| NPI | 1124403100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.009490) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.010187) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2020-10-01 |