| NPI | 1033540240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071-008681) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 020083) |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2013-12-13 |