| NPI | 1508177734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071008794) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY23495) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2015-05-01 |