| NPI | 1770731119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007747) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.007747) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2015-01-06 |