| NPI | 1700297454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 2180) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 00930) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2024-07-26 |