NPI | 1104854892 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-005279) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IL 071-005279) |
Enumeration Date | 2006-06-29 |
Last Update Date | 2017-04-17 |