| NPI | 1588124291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TP0814X Psychologist, Psychoanalysis | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2019-03-20 |