| NPI | 1073820379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5295) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP5295) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2022-05-06 |