NPI | 1417238957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071009238) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2011-08-29 |
Last Update Date | 2016-10-11 |