| NPI | 1780087221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 3755) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 3375) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2021-12-29 |