| NPI | 1316097736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 525) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN 6301002442) |
| 103TS0200X Psychologist, School (Licence: NM 240926) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |