| NPI | 1316324312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.010385) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.009285) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2020-11-09 |