| NPI | 1972739076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 1032) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2009-06-03 |