NPI | 1104930114 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071003885) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL SS881) |
Enumeration Date | 2006-08-18 |
Last Update Date | 2008-03-17 |