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 |