| NPI | 1649372590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP 3081) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 1064) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2014-04-01 |