| NPI | 1578787818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: NY 000817) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R030469) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |