| NPI | 1376770941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1449) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 00232) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2009-06-22 |