| NPI | 1073880027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 5427) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN 5427) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN 5427) | |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2018-03-17 |