| 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 |