| NPI | 1740319821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071003806) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00213) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IA 00512) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-09-25 |