| NPI | 1427065937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP1888) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 1152-057) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071-003420) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-16 |