| NPI | 1366529257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN CC00285) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN 285) |
| 103TC0700X Psychologist, Clinical (Licence: MN 285) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-12-07 |