| NPI | 1134285158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071007665) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3713-125) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2009-12-21 |