| NPI | 1962596825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 1183) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 23948) |
| 106H00000X Marriage & Family Therapist (Licence: AZ 15471) | |
| 106H00000X Marriage & Family Therapist (Licence: WI 999-124) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-10-28 |