| NPI | 1508886045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN LO1030) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP1030) |
| 103TC1900X Psychologist, Counseling (Licence: MN LP1030) | |
| 103TF0000X Psychologist, Family (Licence: MN LP1030) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-02-18 |