| NPI | 1811230469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R025268) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 000809) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2013-04-02 |