| NPI | 1356452163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP 0251) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP0251) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-02-07 |