| NPI | 1427273697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 3297) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 000199) |
| 102L00000X Psychoanalyst (Licence: VT 098-0000005) | |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2007-07-08 |