| NPI | 1144371972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VT 048.0093365) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MN LP4353) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2013-05-07 |