| NPI | 1669711495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5584) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MN LP 5584) |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2024-10-10 |