| NPI | 1700134020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: NY 000038) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 000175-1) |
| 101YP2500X Counselor, Professional (Licence: DC 74) | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2012-08-16 |