| NPI | 1083009575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60931939) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071009027) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-07-16 |