| NPI | 1952407751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5232) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ND 202) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2013-03-11 |