| NPI | 1255484234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA PY 3391 PR) |
| Additional Taxonomies | 103TF0000X Psychologist Family |
| 103TP0814X Psychologist Psychoanalysis | |
| 103T00000X Psychologist | |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2007-07-08 |