| NPI | 1740821214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN LP6876) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CT 004270) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2022-12-07 |