| NPI | 1538571765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 3161-57) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071.008906) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2014-10-14 |