| NPI | 1881915270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071009666) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178010086) |
| 101YP2500X Counselor, Professional (Licence: IL 180010078) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 30340) | |
| Enumeration Date | 2010-06-20 |
| Last Update Date | 2021-08-04 |