| NPI | 1912259219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 102L00000X Psychoanalyst | |
| 103TP0814X Psychologist, Psychoanalysis | |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2012-10-10 |