| NPI | 1427152933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN LP2263) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0265) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-09 |