| NPI | 1003507609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 205062) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK LPCCANDIDATE11237) |
| 106H00000X Marriage & Family Therapist (Licence: OK 11458) | |
| 106H00000X Marriage & Family Therapist (Licence: MD LCM970) | |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2024-03-07 |