| NPI | 1609084359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 6655) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 597) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2008-05-28 |