| NPI | 1093230088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6148) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 3438-57) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2021-03-11 |