| NPI | 1003020728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 000276) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 000571) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2010-06-11 |