| NPI | 1629476973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 2837) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 23335) |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2017-04-07 |