| NPI | 1255435624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 21475) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071002833) |
| 103T00000X Psychologist (Licence: WI 1415057) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 21475) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.002833) | |
| 103TC0700X Psychologist, Clinical (Licence: WI 1415-057) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2009-08-06 |