| NPI | 1912317090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 2259) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc00517) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2022-07-21 |