| NPI | 1245450568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: VT 098000214) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VT 0480000172) |
| 103TC0700X Psychologist, Clinical (Licence: NY 0049131) | |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2007-07-08 |