| NPI | 1851531925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 34549) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 34549) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071007630) | |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2018-03-17 |