NPI | 1740225168 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1841) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 301718) |
Enumeration Date | 2006-06-19 |
Last Update Date | 2011-05-13 |