| NPI | 1760737456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 2487) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP6752) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2026-05-06 |