| NPI | 1629434659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005378) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071005790) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071005790) | |
| 103TH0100X Psychologist, Health Service (Licence: IL 071005790) | |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2016-03-21 |