| NPI | 1104397116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 132044) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TP183-054) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IA 132044) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: IA 132044) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.010460) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2025-11-12 |