| NPI | 1811969447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP0288) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP0288) |
| 103TC0700X Psychologist, Clinical (Licence: MN LP0288) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2025-09-11 |