| NPI | 1609955434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN 1969) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 533) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-07-08 |