| NPI | 1063028306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.021063) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810007923) |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2025-10-22 |