| NPI | 1649380924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2581-057) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.011359) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-02-07 |