| NPI | 1659053189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6998) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ND 647) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2023-11-03 |