| NPI | 1366592693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3803) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 37800) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071006045) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2024-10-03 |