| NPI | 1295507564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 5271-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.021002) |
| 103TH0100X Psychologist, Health Service (Licence: WI 5271-57) | |
| 103TH0100X Psychologist, Health Service (Licence: IL 071.021002) | |
| 103T00000X Psychologist (Licence: IL 071.021002) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: IL 071.021002) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: WI 5271-57) | |
| 103T00000X Psychologist (Licence: WI 5271-57) | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-12-13 |