| NPI | 1083375448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33232) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071010608) |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2022-06-07 |