| NPI | 1902322159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071.009639) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 3491-57) |
| 103TC0700X Psychologist, Clinical (Licence: WI 3491-57) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.009639) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 3491-57) | |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2020-01-31 |