| NPI | 1366597205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP1478) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MN LP1478) |
| 103TS0200X Psychologist School (Licence: MN 302260) | |
| 1041C0700X Social Worker Clinical (Licence: MN 06686) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |