| NPI | 1750703708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.002818) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 180002818) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 180002818) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: IL 180002818) | |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2017-01-11 |