| 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 |