| NPI | 1134465644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.009608) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2662) |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2020-02-14 |