| NPI | 1295813731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP4661) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MN LP4661) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |