NPI | 1184767675 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP2204) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MN LP2204) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP2204) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MN LP2204) | |
Enumeration Date | 2007-02-14 |
Last Update Date | 2010-06-22 |