| NPI | 1063632834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071008173) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61017237) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2023-02-16 |