| NPI | 1336286202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 9120) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 4231-123) |
| 106H00000X Marriage & Family Therapist (Licence: MN 656) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2017-01-13 |