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 |