| NPI | 1902935653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY 129) |
| 102L00000X Psychoanalyst (Licence: VT 0980000222) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2023-10-11 |