| NPI | 1912086588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP1091) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP1091) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MN LP1091) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-07-08 |