| NPI | 1184706350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP5264) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810001916) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2010-08-20 |