| NPI | 1841435039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 3233-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.007571) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2022-03-23 |