| NPI | 1952386708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4578) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071005875) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2016-12-05 |