| NPI | 1336380153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0814X Psychologist, Psychoanalysis (Licence: MN LP0809) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 6630) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2009-03-09 |