| NPI | 1083703987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN LAMFT 1444) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN LPC 0200) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2017-10-30 |