| NPI | 1801001797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO PY 01142) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071 003450) |
| 103TF0200X Psychologist, Forensic (Licence: MO PY 01142) | |
| 103TF0200X Psychologist, Forensic (Licence: IL 071 003450) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-15 |