| NPI | 1437230570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 945) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 300060) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2008-04-24 |