NPI | 1467547257 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP0783) |
Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MN LP0783) |
Enumeration Date | 2006-10-04 |
Last Update Date | 2019-02-06 |