| NPI | 1275633661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071004216) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301008458) |
| 103TC0700X Psychologist, Clinical (Licence: TX 33078) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-04-03 |