| NPI | 1922096791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00085) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00240) |
| 103T00000X Psychologist (Licence: IL 071001889) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2007-07-09 |