| NPI | 1205058427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP3560) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0885) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-09 |