| NPI | 1124035563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 83452) |
| Additional Taxonomies | 103TP0814X Psychologist, Psychoanalysis |
| 1041C0700X Social Worker, Clinical (Licence: OK 1039) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2023-01-29 |