| NPI | 1730306754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 128177) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 71007260) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2019-03-08 |