| NPI | 1497936926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MN 1802) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN LICSW2045) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2007-11-27 |