| NPI | 1821251935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-006485) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 5920) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2008-07-08 |