| NPI | 1972172088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 6340) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 6340) |
| 103TE1100X Psychologist, Exercise & Sports | |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2021-06-22 |