| NPI | 1023244852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0814X Psychologist, Psychoanalysis (Licence: MA 10122) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MA 10122) |
| 102L00000X Psychoanalyst (Licence: MA 10122) | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2015-12-04 |