NPI | 1508177734 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071008794) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY23495) |
Enumeration Date | 2010-06-22 |
Last Update Date | 2015-05-01 |