| NPI | 1639223431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN LP3486) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP3486) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-07-14 |