NPI | 1407811458 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN MN MFT 0758) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SD SD LPC 527) |
103TC1900X Psychologist, Counseling (Licence: SD SD MFT 1013) | |
106H00000X Marriage & Family Therapist (Licence: SD SD MFT 1013) | |
Enumeration Date | 2006-04-20 |
Last Update Date | 2025-09-11 |