NPI | 1326075813 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 06197) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0145) |
Enumeration Date | 2006-06-28 |
Last Update Date | 2008-05-27 |