| NPI | 1518258649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 054409-1) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 054409-1) |
| Enumeration Date | 2011-04-24 |
| Last Update Date | 2015-07-15 |