| NPI | 1326476169 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5665) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP 5665) |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2024-09-19 |