| NPI | 1881832863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071.009667) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180.007082) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2023-09-15 |