NPI | 1013345636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071.008955) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020262-1) |
Enumeration Date | 2013-10-16 |
Last Update Date | 2015-02-20 |