| NPI | 1407951544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 12105) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 106) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2025-09-11 |