| NPI | 1922219070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: MN 2839) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 299) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |