| NPI | 1316007784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 2631) |
| Additional Taxonomies | 103TP0814X Psychologist Psychoanalysis (Licence: NY 565) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |