| NPI | 1003808031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OK 670) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 424) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2025-09-11 |