| NPI | 1184747560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 4267) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 4267) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS-005374-L) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 071-003379) | |
| 103TC0700X Psychologist, Clinical (Licence: PA PS-005374-L) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071-003379) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2008-01-29 |