| NPI | 1790051514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071009038) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 178007486) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2022-09-08 |