| NPI | 1568155067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019259) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071010797) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-10-02 |