| NPI | 1639342140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PY1072) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071007263) |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2022-09-06 |