| NPI | 1942578190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.009790) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.008602) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2018-05-22 |