| NPI | 1588770572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 1987) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071003335) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2018-01-10 |