| NPI | 1194750786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 21981) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 71006214) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-07-07 |