| NPI | 1801986336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1170) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 24988) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT3454) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-01-14 |