| NPI | 1215281480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP 5355) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: MN LP 5355) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |