| NPI | 1285629261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4652) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-003536) |
| 103TH0100X Psychologist, Health Service (Licence: IL 071-003536) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2015-09-22 |