| NPI | 1386868446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD 0005) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC 125) |
| 103TP0814X Psychologist, Psychoanalysis (Licence: MD 3355) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |