| NPI | 1720146012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 2222) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MN LP0550) |
| 106H00000X Marriage & Family Therapist (Licence: MN 657) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |