| NPI | 1154941474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 4354) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305116) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2024-07-30 |