| NPI | 1982666707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP4601) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP4610) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2024-08-19 |