| NPI | 1770705337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 36) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 00563) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2008-05-20 |