NPI | 1750750725 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-009158) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY9254) |
Enumeration Date | 2015-09-21 |
Last Update Date | 2021-04-27 |