| NPI | 1588021307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 07101680) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 37041) |
| 103TC0700X Psychologist, Clinical (Licence: TX 37041) | |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2021-12-14 |