| NPI | 1174590293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP1978) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP1978) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2025-09-11 |