| NPI | 1952137622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071005018) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: IL 071005018) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: IL 071005018) | |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2024-12-04 |