| NPI | 1922344027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: CT PASTORAL PSYCHOTHERA) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT PASTORAL COUNSELOR) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2012-12-17 |