| NPI | 1083040612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 3202) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2013-09-14 |
| Last Update Date | 2023-12-08 |