| NPI | 1447338702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MN LP1531) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MN LP1531) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2016-04-12 |