| 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 |