| NPI | 1962628586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071006568) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IL 071006568) |
| 103T00000X Psychologist (Licence: IL 071006568) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 071006568) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2011-07-09 |