| NPI | 1154320554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 649) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 13403) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2007-07-08 |