| NPI | 1740525609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6124) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PS01265) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2017-04-21 |