| NPI | 1922156405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP5153) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AZ PSY-005759) |
| 103T00000X Psychologist (Licence: MN LP5153) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2024-10-03 |