| NPI | 1588315964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06996) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.010702) |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2026-03-25 |