| NPI | 1003401308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6662) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MN LP6662) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-06-07 |