| NPI | 1154310126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 157) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 409) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2011-12-23 |