| NPI | 1881741783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN LP1239) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP 1239) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2019-04-25 |