| NPI | 1992251672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071.009393) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3400 - 57) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-12-16 |