| NPI | 1235914987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: FL SW10575) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW10575) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2023-08-30 |