| NPI | 1174026652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-010892) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 12163) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2023-08-23 |