NPI | 1003092198 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-0007413) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IL 071007413) |
103TC0700X Psychologist, Clinical (Licence: IN 20042339A) | |
Enumeration Date | 2008-01-18 |
Last Update Date | 2015-11-19 |