| NPI | 1821364001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP5748) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2019-07-04 |