| NPI | 1003121005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3925) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 1945) |
| 102L00000X Psychoanalyst (Licence: NE 3925) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2011-07-18 |