| NPI | 1003586306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 4494) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 3947) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2025-10-05 |