| NPI | 1548542186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301014853) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071008523) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2018-09-20 |