| NPI | 1487766762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007240) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180006118) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-12-26 |