| NPI | 1326435231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 3014) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MN 3014) |
| 101YM0800X Counselor, Mental Health (Licence: MN 3014) | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2018-05-14 |