| NPI | 1700096443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 076975) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 000877) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2013-02-25 |