| NPI | 1942379995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 2526) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 11833) |
| 106H00000X Marriage & Family Therapist (Licence: MN 80) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |