| NPI | 1023358645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 3447-57) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP 5583) |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2025-07-23 |