| NPI | 1679716070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS-004947-L) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: PA PS-004947-L) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2009-04-14 |