| NPI | 1629146386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-001865) |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-12-04 |