| NPI | 1629044631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.005989) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 2520) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2026-05-03 |