| NPI | 1487817789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016953) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071007428) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2024-06-03 |