| NPI | 1811433832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 71-2738) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 71-2738) |
| 103TS0200X Psychologist, School | |
| 104100000X Social Worker | |
| Enumeration Date | 2017-01-14 |
| Last Update Date | 2017-01-14 |