| NPI | 1225575871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IL 071.009431) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071.009431) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: IL 071.009431) | |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2017-01-20 |