| NPI | 1952076556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 4045) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2026-09-25 |