| NPI | 1669583357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071-001934) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 0767) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-01-05 |