| NPI | 1396775235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 0150) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP 1944) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2025-09-11 |