| NPI | 1447477518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 1434) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0625) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-11-09 |