| NPI | 1437427317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.010019) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 4214) |
| 103TC0700X Psychologist, Clinical (Licence: MN 5653) | |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2023-08-03 |