| NPI | 1730516337 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5666) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP5666) |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2023-04-04 |