| NPI | 1538579354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.009626) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.008990) |
| 103T00000X Psychologist (Licence: WI 3500-57) | |
| 103TH0100X Psychologist, Health Service (Licence: IN 20043088A) | |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2019-01-31 |