| NPI | 1316126394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PY0548) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP4845) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2019-02-22 |