| NPI | 1275660433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1583) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071004440) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2022-01-12 |