| NPI | 1528247269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1665) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 1665) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2025-09-30 |