| NPI | 1568572980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-003278) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166-000396) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-08-10 |