| NPI | 1780716977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 00104) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 1325) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-08 |