| NPI | 1083927917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5036) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP5036) |
| 103TF0200X Psychologist, Forensic (Licence: MN LP5036) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP5036) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2023-12-07 |