| NPI | 1972588473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP 1440) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP 1440) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MN LP 1440) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2008-09-24 |