| NPI | 1891323663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 5334-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.010172) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2026-07-11 |