| NPI | 1578922928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 082291) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071.009215) |
| Enumeration Date | 2016-02-14 |
| Last Update Date | 2016-05-25 |