| NPI | 1639256043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: MN LP1411) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP1411) |
| 103TF0000X Psychologist, Family (Licence: MN LP1411) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |