| NPI | 1053645119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6869) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2022-12-12 |