| NPI | 1487768982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040803A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-004894) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2009-03-17 |