| NPI | 1285741819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN LP1457) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 7341) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2012-05-24 |