| NPI | 1851628341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP5140) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 3707) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2023-12-13 |