| NPI | 1982917415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP 5464) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: MN LP 5464) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP 5464) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MN LP 5464) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP 5464) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MN LP 5464) | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2014-11-25 |