| NPI | 1144457326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071.003181) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-003181) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071.003181) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IL 071.003181) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2017-05-12 |