| NPI | 1265648174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 001738) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 000401) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-10-17 |