| NPI | 1104160241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C009504) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW12857) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2016-09-20 |