NPI | 1174822019 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071008091) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 1915) |
Enumeration Date | 2011-03-17 |
Last Update Date | 2011-03-17 |