| NPI | 1528491248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.010081) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 3209) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2025-01-10 |