| NPI | 1043791866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW16359) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: PA cw020032) |
| 1041C0700X Social Worker, Clinical (Licence: PA cw020032) | |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2019-09-23 |