| NPI | 1750750725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-009158) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY9254) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2021-04-27 |