| NPI | 1982697124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 071-001927) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071001927) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071001927) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2020-07-16 |