| NPI | 1104976976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: CA RP277) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: none) |
| 102L00000X Psychoanalyst (Licence: CA RPS277) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2024-08-22 |