| NPI | 1699846154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP2794) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN LP2794) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2016-11-17 |