| NPI | 1467436774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LADC 300151) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP3590) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |