NPI | 1730394073 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 71-3280) |
Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: IL 71-3280) |
103TC0700X Psychologist, Clinical (Licence: IL 71-3280) | |
103TC0700X Psychologist, Clinical (Licence: MO 1999140679) | |
Enumeration Date | 2007-05-11 |
Last Update Date | 2007-07-08 |