| NPI | 1477199636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP6688) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.010179) |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2021-07-07 |