| NPI | 1649514266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071009813) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178008538) |
| 101YP2500X Counselor, Professional (Licence: IL 180009783) | |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2019-06-11 |