| NPI | 1689756579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071-007187) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180004821) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2024-04-17 |