| NPI | 1457421810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071005436) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2012-02-03 |