| NPI | 1629288592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 003438) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 000574) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-05-22 |