| NPI | 1699864660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1071) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 1071) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2018-06-08 |