| NPI | 1487956033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5239) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP5239) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2011-05-26 |