| NPI | 1669867511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3823) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MN LP3823) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2018-03-17 |