| NPI | 1063507713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 15371) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.004866) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-10-11 |