| NPI | 1164446837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 1807) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 000204) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |