| NPI | 1891851580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP4546) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP4546) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2018-05-24 |