| NPI | 1063729747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: MN 2740) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 2740) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2023-04-03 |