| NPI | 1548431729 |
|---|---|
| Other Name | NONE NONE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 7117) |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2008-03-17 |