| NPI | 1528427481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 8249) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 500) |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2016-02-19 |