| NPI | 1700823390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.011161) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 296) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-12-10 |