| NPI | 1992776686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP5994) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 3189) |
| 103T00000X Psychologist (Licence: DE B10000591) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 35105) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2019-06-27 |