| NPI | 1437401783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 5652) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 9594) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2013-09-27 |