| NPI | 1619086931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH005982) |
| Additional Taxonomies | 103TP0814X Psychologist, Psychoanalysis (Licence: NM 5982) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-07-07 |