| NPI | 1821361882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 5536) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA 003491) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2026-03-12 |