| NPI | 1548318892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3982) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071006204) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2010-02-17 |