| NPI | 1255962148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071011126) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3891-57) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2026-04-20 |