| NPI | 1225345564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 03024) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071.009870) |
| 103T00000X Psychologist (Licence: TX 37434) | |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2021-12-28 |