| NPI | 1053063479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LGP12333) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: MD LGP12333) |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2022-01-26 |