| NPI | 1144476524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.008658) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 2104) |
| Enumeration Date | 2008-08-17 |
| Last Update Date | 2023-11-08 |