| NPI | 1215957618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00402) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071-002353) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2013-04-12 |