| NPI | 1538172812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38072) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-005909) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2018-12-26 |