| NPI | 1003069915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 4962) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 4962) |
| 102L00000X Psychoanalyst (Licence: SC 4962) | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2008-10-23 |