| NPI | 1538177563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 01175) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071004359) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2015-05-13 |