| NPI | 1962624932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: NY 069942) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NJ 44SC05322100) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2007-07-08 |