| NPI | 1861673030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP0553) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 3705) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2007-11-16 |