| NPI | 1588762108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071007090) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: IN 20042218A) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-11-04 |