| NPI | 1376996991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071009860) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2017002001) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2022-12-07 |