| NPI | 1174652408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS1128) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071003158) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2007-07-08 |