| NPI | 1831348762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1550) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071007880) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2021-03-03 |