| NPI | 1861669772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SD 523) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP4918) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2014-09-10 |