| NPI | 1710048350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LPP 0119) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 00436) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |