| NPI | 1063695518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: NY 83299) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 83299) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2020-05-22 |