| NPI | 1366852972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP7120) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 21317) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2024-11-04 |