| NPI | 1982843777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301015753) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071007832) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2023-10-31 |