| NPI | 1083197545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 102L00000X Psychoanalyst |
| Additional Taxonomies | 101Y00000X Counselor |
| 103K00000X Behavior Analyst | |
| 104100000X Social Worker | |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2018-09-11 |