| NPI | 1154403673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 191) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP0637) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2025-09-11 |