| NPI | 1104351337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0019714) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: CO NLC.0111022) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2023-08-23 |