| NPI | 1306698212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP3465) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP3465) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2024-04-08 |