| NPI | 1316391675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071009279) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071009279) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IL 071009279) | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2019-06-19 |