| NPI | 1467444604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071006828) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20041938A) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2020-09-10 |