| NPI | 1306951678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY.0002867) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-007430) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 4373) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2022-03-16 |