| NPI | 1093590564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP7145) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP7145) |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2025-01-27 |