| NPI | 1427264928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP1408) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0235) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2014-12-16 |