| NPI | 1740691542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071008865) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004806) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2017-02-14 |