| NPI | 1609085943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: FL PY0003540) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY0003540) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY0003540) | |
| 103TH0004X Psychologist, Health (Licence: FL PY0003540) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |