| NPI | 1770642217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP1480) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP1480) |
| 103TF0000X Psychologist, Family (Licence: MN LP1480) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MN LP1480) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2008-10-17 |