| NPI | 1205959962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6401) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00865) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2019-06-26 |