| NPI | 1285772657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MN 260873) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 5112) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2025-09-11 |