| NPI | 1487787313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 3784) |
| Additional Taxonomies | 103TP0814X Psychologist Psychoanalysis (Licence: MA 3784) |
| 103T00000X Psychologist (Licence: MA 3784) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |