| NPI | 1265509780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP1812) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP1812) |
| 103TP0814X Psychologist Psychoanalysis (Licence: MN LP1812) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2018-01-18 |