| NPI | 1912070350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VT 048.0122895) |
| Additional Taxonomies | 103TP0814X Psychologist Psychoanalysis (Licence: VT 098-0000177) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-09-20 |