| NPI | 1306911821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP3858) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ND 315) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2022-07-21 |