| NPI | 1508932435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 001074) |
| Additional Taxonomies | 103TP0814X Psychologist, Psychoanalysis (Licence: NY 000539) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2020-01-13 |