| NPI | 1730394073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 1999140679) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 71-3280) |
| 103TR0400X Psychologist, Rehabilitation (Licence: IL 71-3280) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 71-3280) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2025-09-11 |