| NPI | 1083676977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071004718) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 1075) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.004718) | |
| 103T00000X Psychologist (Licence: WI 2606) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2024-05-29 |