NPI | 1285169094 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071003833) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166000417) |
Enumeration Date | 2017-04-30 |
Last Update Date | 2017-04-30 |