NPI | 1578186219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.010284) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071.010284) |
Enumeration Date | 2020-05-27 |
Last Update Date | 2020-07-08 |