NPI | 1538579354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.009626) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.008990) |
103T00000X Psychologist (Licence: WI 3500-57) | |
103TH0100X Psychologist, Health Service (Licence: IN 20043088A) | |
Enumeration Date | 2014-05-01 |
Last Update Date | 2019-01-31 |