| NPI | 1073826913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 5269) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN 5269) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MN 5269) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2010-07-20 |