| NPI | 1841204989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 2908) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0136) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2009-04-20 |