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 |