| NPI | 1861092686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.010375) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: IL 071.010375) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |