| NPI | 1619396736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071009106) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2016-01-25 |