| NPI | 1366964900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.011052) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.011842) |
| 103TC0700X Psychologist, Clinical (Licence: IL 178.011842) | |
| 103TC0700X Psychologist, Clinical (Licence: IA 110710) | |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2023-11-09 |