| NPI | 1184804718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5007) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1852-057) |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2021-11-11 |