| NPI | 1437460987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 3591) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ND 443-5-1-00-337) |
| 101YP2500X Counselor, Professional (Licence: ND 443-5-1-00) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2019-02-15 |