| NPI | 1326822743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071-004370) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301017390) |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2023-08-28 |