| NPI | 1497390298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11865) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ND 576) |
| 103T00000X Psychologist (Licence: MN LP6456) | |
| 103TC0700X Psychologist, Clinical (Licence: MN LP6456) | |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2022-08-16 |