NPI | 1053467258 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071005287) |
Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071005287) |
103TC2200X Psychologist, Clinical Child & Adolescent | |
Enumeration Date | 2007-01-28 |
Last Update Date | 2023-07-14 |