| NPI | 1700089158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R043298) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 000531) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2011-10-03 |