| NPI | 1629347000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC3456) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: GA LPC3456) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2011-12-14 |