| NPI | 1043268337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 1137) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP1137) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2017-10-10 |