| NPI | 1164903050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6639) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301017524) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2024-01-30 |