| NPI | 1912012626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 71007282) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20042160A) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2023-10-10 |