NPI | 1861618134 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: UT 7318482-2501) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.007348) |
Enumeration Date | 2007-04-17 |
Last Update Date | 2012-05-16 |