| NPI | 1548563596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 1973) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071008025) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2016-05-23 |