| NPI | 1477720761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS004383L) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 134) |
| 103T00000X Psychologist (Licence: PA PS004383L) | |
| 103T00000X Psychologist (Licence: MA 3382) | |
| 103TC0700X Psychologist, Clinical (Licence: MA 3382) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2008-05-15 |