| NPI | 1396116133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 11488) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071009159) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2021-11-02 |