| NPI | 1376071316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 15507) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN 15507) |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2024-04-04 |