| NPI | 1174979132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071010748) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME PS2598) |
| 103T00000X Psychologist (Licence: UT 10368133-2501) | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2024-11-07 |