| NPI | 1659580330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP4567) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: MN LP4567) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-07-21 |