| NPI | 1770842742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3021) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071007409) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2012-05-11 |