| NPI | 1396858908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3077) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP3077) |
| 103TH0100X Psychologist, Health Service (Licence: MN LP3077) | |
| 103T00000X Psychologist (Licence: MN LP3077) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |