| NPI | 1255829081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.010644) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301017411) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2024-02-28 |