| NPI | 1457339012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 2420) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 194) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2007-07-08 |