| NPI | 1811339302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 020793) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 000897) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2019-06-10 |