| NPI | 1912984410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP4572) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN LP4572) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2007-07-08 |