| NPI | 1760616056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1934) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071005185) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2009-05-14 |