| NPI | 1700467180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.010504) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 06500) |
| Enumeration Date | 2021-04-18 |
| Last Update Date | 2024-05-01 |