| NPI | 1841256831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP 1545) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071002007) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2007-07-08 |