| NPI | 1588740237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 5608) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 2704-057) |
| 103T00000X Psychologist (Licence: MN LP5608) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-08-24 |