| NPI | 1063729747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP2701X Psychologist Group Psychotherapy (Licence: MN 2740) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MN 2740) |
| 101YM0800X Counselor Mental Health (Licence: MN 2740) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2024-08-13 |