| NPI | 1255465803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 179) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: MN LP0994) |
| 103TF0200X Psychologist, Forensic (Licence: MN LP0994) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MN LO0994) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2025-09-11 |