| NPI | 1629133996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP6307) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 71005077) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2019-06-11 |