| NPI | 1003276957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.009445) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: WI 3420-57) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2016-12-07 |