NPI | 1477861250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NM 1139) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071008152) |
Enumeration Date | 2010-09-15 |
Last Update Date | 2013-01-18 |