| NPI | 1770909673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY-004891) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071.009281) |
| 103TC0700X Psychologist Clinical (Licence: TX 39638) | |
| 103TC0700X Psychologist Clinical (Licence: IN 20042750A) | |
| Enumeration Date | 2014-03-15 |
| Last Update Date | 2023-09-05 |