| NPI | 1588857072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP3351) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MN LP3351) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2022-08-02 |