| NPI | 1821494022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL 0471010316) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: VT 102L00000X) |
| Enumeration Date | 2014-11-15 |
| Last Update Date | 2016-05-19 |