| NPI | 1093795254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-003249) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 00511) |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2018-01-20 |