| NPI | 1740370402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP1295) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 196) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2007-09-05 |