NPI | 1275505760 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 0374) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0364) |
Enumeration Date | 2006-02-07 |
Last Update Date | 2007-07-08 |