| NPI | 1972724946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: NY 000797) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NJ 48PA000060000) |
| 101YP1600X Counselor, Pastoral (Licence: NC 118) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2026-03-12 |