| NPI | 1164779476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071-009160) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: 071.009160) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2024-06-24 |