| NPI | 1700493848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071010409) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3855-57) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2021-02-25 |