| NPI | 1134241409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1446) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NE 4783) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2016-09-09 |