| NPI | 1790986115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2007027060) |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-12-22 |