| NPI | 1568424133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071007868) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: GA PSY003467) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2011-11-01 |