| NPI | 1770789307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NV PY0975) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071007249) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2024-10-11 |