| NPI | 1609247048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5924) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN 5924) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2021-07-26 |