| NPI | 1194951178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302652) |
| 101YM0800X Counselor, Mental Health | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TF0000X Psychologist, Family | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MN 302652) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TP0814X Psychologist, Psychoanalysis | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2017-02-20 |