| NPI | 1871103838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071010597) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 108386) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2021-09-08 |