| NPI | 1134343767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN LICSW 1759) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0459) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-12-12 |