| NPI | 1558455659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 2662) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ND 80-5-22-91-107) |
| 106H00000X Marriage & Family Therapist (Licence: MN 774) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-10-30 |