| NPI | 1255383824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP4334) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP4334) |
| 103TC0700X Psychologist, Clinical (Licence: MN LP4334) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-04-23 |