| NPI | 1750019287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TP0814X Psychologist Psychoanalysis | |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2022-08-11 |