| NPI | 1588779292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP1788) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1535-057) |
| 103T00000X Psychologist (Licence: MN 716) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2021-12-02 |