| 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 |