| NPI | 1770713893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 1179) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: ZZ 427) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2018-07-20 |