NPI | 1114106697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071007372) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 071007372) |
Enumeration Date | 2007-10-31 |
Last Update Date | 2007-10-31 |