| NPI | 1932100369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: MI 43010-28241) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 43010-28241) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 43010-28241) | |
| 103TF0000X Psychologist Family (Licence: MI 43010-28241) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: MI 43010-28241) | |
| 102L00000X Psychoanalyst (Licence: MI 4301028241) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: MI 43010-28242) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-02-18 |