| NPI | 1750484937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 0012241) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS002377L) |
| 103TP0814X Psychologist Psychoanalysis (Licence: NY 0000201) | |
| 103TH0100X Psychologist Health Service (Licence: 19447) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2007-07-08 |