| NPI | 1407479447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301018413) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: IL 071009794) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2021-06-14 |