| NPI | 1164130100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.020406) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 101YM0800X) |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2024-07-31 |