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 |