| NPI | 1639285596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1254) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302753) |
| 101YM0800X Counselor, Mental Health (Licence: MN 1228) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2021-08-01 |